Nasal polyps
Nasal polyps are special outgrowths of hypertrophied nature on the mucous membrane of the nasal cavity (or paranasal sinuses). Polyps in the nose are characterized by a gradual course, which leads to a special violation of nasal breathing, as well as to a decrease or even disappearance of the sense of smell. Sleep disorders, hearing impairment, headache, decreased performance, malocclusion and impaired speech development in a child — all these can be the consequences of difficulty breathing through the nose. Nasal polyps are usually diagnosed after the results of an endoscopic examination in the nasal cavity become known. Also, tomographic examination and X-ray of the paranasal sinuses are methods of effective diagnosis. Pharyngoscopy, a general blood test, otoscopy and bacteriological examination can be performed as additional diagnostic methods. Usually nasal polyps are surgically removed with further postoperative treatment.
The content of the article:
Causes of nasal polyps
Symptoms and signs of a nasal polyp
Diagnosis of nasal polyps
Complications of nasal polyps
Nasal polyps: treatment and its methods
Prognosis and prevention of nasal polyps
Nasal polyps
Nasal polyps are a fairly common pathology. According to statistics, the disease occurs in 4% of people. Nasal polyps are more common in men than in women. The appearance of polyps in the nose begins with excessive growth of the nasal mucosa, which is a consequence of a prolonged inflammatory process in the nose. As you know, the fight against inflammation is constantly taking place in the nasal mucosa. It is the nasal mucosa that weakens or compensates for various pathological reactions. Over time, there is a depletion of the protective function of the mucous membrane itself. At the next stage, the compensatory mechanism is activated, which increases the area of the mucosa, due to hypertrophic overgrowth, which leads to the development of polyps in the nose.
Causes of nasal polyps
In modern otolaryngology, nasal polyps are considered a polyethological disease. There are many factors that contribute to the appearance of polyps in the nose: these are anatomical features of the structure of the nasal cavity (narrow nasal passage or curvature of the nasal septum), and the chronic inflammatory process occurring in the paranasal sinuses (sinusitis, frontitis, ethmoiditis and others), and even allergic diseases in the respiratory tract (allergic rhinitis, bronchial asthma and others).
Symptoms and signs of a nasal polyp
The growth of polyps in the nose begins in the latticed sinus, as well as in the upper parts of the nasal cavity. At the initial stage of its development, all changes in the nose remain unnoticeable for some time. Over time, the polyps increase in size, and this leads to difficulty in nasal breathing. In order to facilitate breathing through the nose, a person uses vasoconstrictive drops. At first, they relieve the patient’s condition by removing the swelling of the mucous membrane, but if the polyps in the nose have reached large sizes, then such drops will not help.
Violation of nasal breathing, which is associated with polyps growing in the nose, can lead to excessive fatigue of the patient, as well as to a decrease in his mental performance and the appearance of headaches, not to mention sleep disorders. Patients usually complain of a significantly impaired sense of smell, which can lead to a complete loss of feeling any odors (the so-called anosmia). Another characteristic symptom that appears in the patient is a feeling of the presence of a foreign body or a feeling of any other discomfort. Runny nose is another important symptom indicating the presence of polyps. Pain in the paranasal sinuses is also often noted.
It is also interesting that in a patient suffering from polyps in the nose, the voice often changes, which acquires a nasal tinge. Overgrown polyps often block the entrance that connects the nasopharynx and the auditory tube, which leads to hearing loss and the development of hearing loss, and in a child — to a clear violation of speech development.
If polyps appear in a child at an early age, this may indicate an incorrect formation of the facial skull or the maxillary system, which is manifested by malocclusion. Children in the first year of life suffering from polyps may also suffer from a disorder of sucking or swallowing, and this leads to malnutrition and possible hypotrophy.
Diagnosis of nasal polyps
Violation of nasal breathing can be determined even if the patient does not have any characteristic complaints. The latter is possible if the patient has a nasal tone of voice. Problems with the nose are easy to identify in a child. Symptoms will be: an open mouth with a drooping lower jaw, a change in the nasolabial fold, and more.
Of course, the first thing a doctor should do is to identify the cause of nasal breathing disorders, because in addition to polyps, adenoids, foreign bodies, benign tumors, choan atresia and synechiae of the nasal cavity can become the cause of problems with the nose. Patients are often prescribed rhinoscopy, which is able to detect the presence or absence of cluster-like growths on the mucous membrane.
Another diagnostic method is CT of the paranasal sinuses. As you know, CT is a study that allows you to determine the volume of the operation in advance and deliberately develop tactics for surgical intervention. An alternative can also serve as an X-ray.
Pharyngoscopy, otoscopy, microlaryngoscopy, bakposev — all these diagnostic methods will help to identify nasopharyngeal disease. Also, when assessing the inflammatory process, the results of a clinical blood test (the level of ESR and the degree of leukocytosis) are important. Allergological tests are prescribed to those patients who have polyps as a result of allergic diseases.
Complications of nasal polyps
If breathing is normal, then it performs its main function — it provides warming and humidification of the air that enters the nasal cavity, not to mention cleaning the air from dust particles settling on the nasal mucosa. The appearance of polyps creates some difficulties, preventing the normal passage of air through the nasal cavity and forcing the patient to replace nasal breathing with mouth breathing. As a result, cold air enters the respiratory tract, cooling them. The latter can lead to the development of diseases such as laryngitis, laryngotracheitis, pharyngitis, bronchitis and even pneumonia.
It should also be said that nasal polyps can block the passage from the nasal cavity into the cavity of the paranasal sinuses, which will lead to the onset of the inflammatory process and possibly even to the development of sinusitis. Large polyps can lead to compression of blood vessels, which means that blood supply to nasopharyngeal tissues is disrupted. The latter causes frequent inflammation of the pharyngeal tonsils with the further development of adenoids, angina or tonsillitis.
Nasal polyps: treatment and its methods
The treatment of nasal polyps involves conservative, surgical and anti-relapse treatment.
Conservative treatment
Conservative treatment, first of all, is aimed at eliminating all possible factors that provoked nasal polyps. The latter includes the exclusion of infectious effects on the body, the exclusion of the action of food allergens (flavoring additives, for example), as well as the process of sanitizing the foci of chronic infections themselves. Conservative treatment involves the treatment of inflammatory diseases of the nasopharynx, antiallergic therapy, as well as immunocorrection. “Purely” conservative treatment of nasal polyps cannot provide the desired result. It is always part of a combination therapy, after which surgical treatment is prescribed to remove them.
Conservative treatment also refers to the type of treatment in which polyps are removed by resorting to thermal effects. It is usually prescribed to those patients who are contraindicated for surgical intervention due to respiratory insufficiency, blood clotting disorders, in the presence of hypertension or ischemic disease, as well as in severe forms of bronchial asthma. It is possible to carry out thermal effects in the treatment of nasal polyps with the help of a thin quartz fiber. As you know, when heated to a temperature of 70 degrees, the nasal polyps become white and after a day or two their rejection from the nasal mucosa begins, after which they are removed with tweezers or independently by blowing.
Surgical treatment
Usually surgical treatment is prescribed to patients with an advanced form of nasal polyps, when there is a partial or complete loss of sense of smell, the disease is accompanied by sinusitis, frequent attacks of severe bronchial asthma, fever and snoring. Of course, if the doctor detects polyps at the time of a severe exacerbation of bronchial asthma, then surgical intervention is postponed until the arrival of remission. Surgical removal of nasal polyps is performed by different methods, which differ from each other in both the technique of execution and the degree of possible injury, as well as effectiveness.
Today, such a method is still often practiced in which polyps are removed using a special polyp loop, as well as a number of other surgical instruments. However, this method has a big drawback — only polyps located in the nasal cavity are removed. Since polyps most often occur in the paranasal sinuses, due to the polypous tissue remaining in it, new polyps can grow, which is often observed in the first two years after the operation. Another disadvantage of removing polyps with a loop is the high risk of injuring the patient and causing bleeding.
Perhaps the most painless method of removing polyps is laser removal. Such an operation is performed on an outpatient basis with the use of local anesthesia. Doctors guarantee painlessness and sterility. The final recovery of the patient after surgery takes place within the next 2-4 days.
The most effective and innovative method is the endoscopic removal of polyps in the nose. This method is accompanied by the possibility of endovideosurgical display of the image on the monitor. Polyps are removed using a special power tool by pulling the polypous tissue into the hole of the tip of this tool itself. Due to the high accuracy and clear visualization, the polypous tissue is removed more efficiently than by other methods. It means that when removed by this method, the occurrence of relapses is extremely rare. An interesting fact is that by applying this method in practice, the surgeon can also correct the internal anatomical structure of the nose to improve the drainage of the paranasal sinuses. The result is the creation of optimal conditions for the most effective postoperative treatment.
Anti-relapse treatment
As you know, after the removal of polyps after some time, they can occur again and again, thereby having a tendency to relapse. To avoid the latter, doctors advise the patient to undergo a mandatory course of postoperative (or anti-relapse) treatment. Usually, postoperative care for the newly operated nasal cavity should take place within the next 7-10 days. It is best that the appropriate procedures for washing and cleaning the nasal cavity are carried out by an otolaryngologist. If there is no such possibility, then the patient must independently perform all prescribed procedures, even at home. The latter involves washing the nasal cavity with a saline solution. This is done using a syringe or a special rubber pear. Today, doctors also prescribe special sprays. If the operation to remove polyps was carried out in a person prone to allergies, then the doctor, as a rule, also prescribes antihistamines, which can be erius, claritin or loratadine.
A 3-month treatment with corticosteroids in the form of metered-dose inhalations may also be prescribed in order to clear the nasal cavity. One of the best such drugs today is considered to be “Flixonaz”. Doctors note that local treatment with corticosteroids does not have any side effects. On the contrary, this type of treatment is the most effective, especially if the polyps were removed endoscopically, which can provide excellent patency of the channels between the nasal cavity and the paranasal sinuses. It is the endoscopic removal that will help corticosteroids penetrate into the sinuses.
Of course, any patient suffering from nasal polyps should be constantly monitored by an otolaryngologist. This is especially true for those who have had surgery to remove polyps. The minimum follow-up period for such patients with an otolaryngologist will be 1 year. In general, it is recommended to visit a doctor at least once every three months. In addition, patients suffering from allergies should also be monitored by an allergist.
Prognosis and prevention of nasal polyps
Of course, none of the listed methods of treatment guarantees complete and final disposal of nasal polyps. As practice shows, this disease is so parasitic that polyps almost always appear again and again. It is believed that the operation is carried out effectively only when the polyps begin to recur no earlier than six years after their initial removal. If treatment is not provided in time, then this disease can contribute to the development of persistent anosmia. The latter means that it is impossible to fully restore the sense of smell. The patient may lose the ability to perceive odors even after surgery.
Of course, the main thing in the prevention of polyps is timely treatment and detection of allergic diseases. Prevention also involves eliminating the causes and prescribing the right treatment. Early diagnosis of any infectious and inflammatory process occurring in the nasopharynx, as well as its elimination, is also a sure way of prevention in order to prevent the disease from becoming chronic.
